Treatment of Giant Cell Arteritis in the ARTESER Multicenter Study of 1675 Patients

Jesús T. Sánchez-Costa¹, Iñigo Hernández-Rodríguez², Elisa Fernández-Fernández³, María T. Silva-Diaz⁴, Jesús A. Valero-Jaimes⁵, Ismael González-Fernández⁶, Julio Sánchez⁷, Judit Lluch⁸, Eva Galindez-Agirregoikoa⁹, Javier Mendizábal-Mateos¹⁰, Pia M. Lois Bermejo¹¹, Javier Loricera¹², Alejandro Muñoz¹³, Cristina Valero-Martínez¹⁴, Patricia Moya¹⁵, Carmen Larena-Grijalba¹⁶, Vanessa A. Navarro-Angeles¹⁷, Joan Calvet-Fontova¹⁸, Ivette Casafont¹⁹, Francisco Ortiz-Sanjuán²⁰, Selene Labrada-Arrabal²¹, Jaime Calvo-Alén²², Carlota L. Iñiguez-Ubiaga²³, Vanesa Hernández²⁴, Cristina Campos-Fernández²⁵, María Alcalde-Villar²⁶, Antonio Juan-Mas²⁷, Eugenio De Miguel²⁸, Javier Narvaez²⁹, Miguel Ángel gonzalez-Gay³⁰, Noemí Garrido-Puñal³¹, Paula V. Estrada-Alarcon¹⁷ and Ricardo Blanco³², ¹Spanish Society of Rheumatology, Madrid, Spain, ²Complejo Hospitalario Universitario de Vigo, Vigo, Spain, ³Rheumatology department, La Paz University Hospital, Madrid, Spain, ⁴Complejo Hospitalario Universitario de La Coruña, Coruña, Spain, ⁵Hospital Universitario Donostia, Donostia-San Sebasti, Spain, ⁶Hospital Universitario de León, León, Spain, ⁷Hospital Universitario 12 de Octubre, Madrid, Spain, ⁸Hospital Universitari Bellvitge, Hospitalet de Llobregat, Spain, ⁹Hospital Universitario de Basurto, Bilbao, Spain, ¹⁰H. Navarra, Navarra, Spain, ¹¹Rheumatology Department, Hospital Clínico San Carlos, Madrid, Spain, ¹²Hospital Universitario Marqués de Valdecilla, Santander, Spain, ¹³Hospital Universitario Virgen del Rocío, Sevial, Spain, ¹⁴Hospital Universitario de La Princesa, Madrid, Spain, ¹⁵Hospital Sant Pau, Barcelona, Spain, ¹⁶Rheumatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain, ¹⁷Hospital de Sant Joan Despí Moisès Broggi. Sant Joan Despí, Barcelona, Spain, ¹⁸Hospital Universitari Parc Tauli, Sabadell, Spain, ¹⁹Hospital Universitari Germans Trias i Pujol, Barcelona, Badalona, Spain, ²⁰H. La Fe, Valencia, Spain, ²¹Hospital del Mar, Barcelona, Spain, ²²Rheumatology Department, Hospital Universitario Araba, Vitoria-Gasteiz, Spain, ²³Hospital Universitario Lucus Augusti, Lugo, Spain, ²⁴Rheumatology Department, Hospital Universitario de Canarias, La Laguna, Spain, ²⁵Consorci Hospital General Universitari de Valencia, Valencia, Spain, ²⁶Hospital Universitario Severo Ochoa, Leganés, Spain, ²⁷Hospital Universitario Son Llàtzer, Palma de Mallorca, Spain, ²⁸Hospital Universitario La Paz, Madrid, Spain, ²⁹Division of Rheumatology, Hospital Universitario de Bellvitge, Barcelona, Spain, ³⁰Research group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla; School of Medicine, Universidad de Cantabria, Santander, Spain. Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, ³¹Hospital Universitario Virgen del Rocío, Sevilla, Spain, ³²Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain

Meeting: ACR Convergence 2021

Keywords: corticosteroids, giant cell arteritis, glucocorticoids, longitudinal studies, Vasculitis

Session Information

Date: Monday, November 8, 2021

Session Title: Vasculitis – Non-ANCA-Associated & Related Disorders Poster I: Giant Cell Arteritis & Polymyalgia Rheumatica (1391–1419)

Session Type: Poster Session C

Session Time: 8:30AM-10:30AM

Background/Purpose: Glucocorticoids (GC) are the mainstay therapy in Giant Cell Arteritis (GCA), initially at high doses (40-60 mg/day) followed by gradual glucocorticoid tapering. This treatment, especially in older patients, is associated with numerous adverse effects (AE). In addition, there are frequent relapses. Therefore, conventional synthetic immunosuppressants such as methotrexate (MTX), leflunomide, azathioprine, cyclophosphamide or mycophenolate, have been used with controversial results. Studies with biological immunosuppressants, such as TNFi have been ineffective; in contrast, tocilizumab (TCZ) has obtained positive results and was approved for the treatment of GCA.

In the ARTESER study we describe a) treatment with GC, synthetic or biological immunosuppressants and concomitant treatments; b) AE of CG; and c) evolution.

Methods: ARTESER is a retrospective observational study sponsored by the Spanish Society of Rheumatology. 26 Spanish centers participated and all new patients diagnosed with GCA from June 1, 2013 to March 29, 2019 were included. Data on GC and immunosuppressants were collected at the beginning and during the follow-up of GCA patients. For the calculation of the cumulative dose of GC, an application was developed that, by including the periods of time, dose and type of GC received during follow-up, performs the automatic calculation in mg of prednisone.

Results: Of the 1675 patients included, GC treatment was adequately recorded in 1650 patients (Table 1). All received oral treatment, being prednisone the most frequently drug used (N=1602, 97.09%). In addition, 426 (25.82%) patients received at least one iv pulse of methylprednisolone, being the 1000 mg regimen the most frequent (n=217; 50.9%). The total mean duration of GC treatment was 22.65 months. The mean cumulative dose per patient at the end of follow-up was 8514.98 mg of prednisone.

The most prescribed concomitant treatment at the time of diagnosis of GCA was calcium (n=1281, 76.9%), vitamin D (n=1258, 75.6%) and bisphosphonates (n=831, 50.1%). The most widely used immunosuppressant was MTX both at diagnosis (n=165; 9.9%) and during follow-up (n=532; 31.8%), followed by TCZ, at diagnosis (22; 1.3%) and at follow-up (153; 9.1%).

AE with GC were described in 393 patients (23.8%), highlighting serious infections (n=67; 10.03%) followed by diabetes mellitus (n=63; 9.43%), steroid myopathy (n=53; 7.9%), vertebral fractures (n=47; 7.04%), non-vertebral fractures (n=36; 5.39%), heart failure (n=36; 5.39%), arterial hypertension (n=34; 5.09%) and neuropsychiatric alterations (n=27; 4.04%).

During the follow-up, 334 (19.9%) patients had relapses, 532 (31.8%) were hospitalized on some occasion, and 142 patients (8.48%) died. The main cause of death were infections (n=44; 30.99%), neoplasms (n=23; 16.2%), cardiovascular (n=15; 10.56%), and cerebrovascular (n=10; 7.04%).

Conclusion: The main treatment for GCA was oral GC, which were required for almost two years on average, in a quarter of patients associated with IV pulses. The cumulative steroid dose was high as well as the side effects. MTX was the most widely used immunosuppressant and TCZ was prescribed in 10%. Relapses and admissions at the hospital were relatively frequent.

Table 1. Corticosteroid treatment

Table 2. Immunosuppressant and concomitant treatments

Disclosures: J. Sánchez-Costa, None; I. Hernández-Rodríguez, None; E. Fernández-Fernández, None; M. Silva-Diaz, None; J. Valero-Jaimes, None; I. González-Fernández, None; J. Sánchez, None; J. Lluch, None; E. Galindez-Agirregoikoa, None; J. Mendizábal-Mateos, None; P. Lois Bermejo, None; J. Loricera, None; A. Muñoz, None; C. Valero-Martínez, None; P. Moya, None; C. Larena-Grijalba, None; V. Navarro-Angeles, None; J. Calvet-Fontova, None; I. Casafont, None; F. Ortiz-Sanjuán, None; S. Labrada-Arrabal, None; J. Calvo-Alén, None; C. Iñiguez-Ubiaga, None; V. Hernández, None; C. Campos-Fernández, None; M. Alcalde-Villar, Nordic, 12, Tutor of rheumatology trainee at regional congress; A. Juan-Mas, None; E. De Miguel, Roche, 6, 12, Paid instructor, Abbvie, 2, 5, 6, Novartis, 2, 5, 6, 12, Paid instructor, Pfizer, 2, 5, 6, MSD, 6, BMS, 6, UCB, 6, Grunental, 6, Janssen, 6, 12, Paid instructor, Sanofi, 6, Galapagos, 2; J. Narvaez, None; M. gonzalez-Gay, None; N. Garrido-Puñal, None; P. Estrada-Alarcon, None; R. Blanco, Brystol Myers Squibb, 6.

To cite this abstract in AMA style:

Sánchez-Costa J, Hernández-Rodríguez I, Fernández-Fernández E, Silva-Diaz M, Valero-Jaimes J, González-Fernández I, Sánchez J, Lluch J, Galindez-Agirregoikoa E, Mendizábal-Mateos J, Lois Bermejo P, Loricera J, Muñoz A, Valero-Martínez C, Moya P, Larena-Grijalba C, Navarro-Angeles V, Calvet-Fontova J, Casafont I, Ortiz-Sanjuán F, Labrada-Arrabal S, Calvo-Alén J, Iñiguez-Ubiaga C, Hernández V, Campos-Fernández C, Alcalde-Villar M, Juan-Mas A, De Miguel E, Narvaez J, gonzalez-Gay M, Garrido-Puñal N, Estrada-Alarcon P, Blanco R. Treatment of Giant Cell Arteritis in the ARTESER Multicenter Study of 1675 Patients [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/treatment-of-giant-cell-arteritis-in-the-arteser-multicenter-study-of-1675-patients/. Accessed June 1, 2023.

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